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Combination of intraoperative ultrasonography for localizing insulinoma under Da Vinci robotic surgical system: experience of a single center in 50 cases.

Xianlin HAN ; Wenming WU ; Mengyi WANG ; Lin CONG ; Quan LIAO ; Menghua DAI ; Taipin ZHANG ; Yupei ZHAO

Chinese Journal of Surgery.2016;54(1):30-33. doi:10.3760/cma.j.issn.0529-5815.2016.01.008

OBJECTIVETo evaluate the effect and safety of enucleation of insulinoma under the Da Vinci robotic surgical system combination with intraoperative ultrasonography(IOUS) for the localization.

METHODSThe clinical materials of 50 insulinoma cases which underwent IOUS and assisted by the robotic surgical system from September 2012 to September 2014 in Peking Union Medical College Hospital were reviewed retrospectively. The patients were followed up by outpatient review and telephone until October 2014. The diagnostic accuracy rate, operation time, blood loss, complications and cure rate were analyzed by t-test.

RESULTSThe locations of tumors were 13 in the head, 21 in the body and 13 in the tail of pancreas, 2 were multiple insulinoma, 1 was ectopic to mesenterium.The average operation time was 142 minutes; the average blood loss was 165 ml.Three(6.0%) patients were transformed to open.One patient experienced postoperative bleeding about 300 ml on the 7(th) day after operation and no infection and perioperative death.Thirty-five cases were of class A and 14 of class B according to the clinical grading of postoperative pancreatic fistula.The blood glucose 60 minutes after tumor dissection was significantly elevated than that before operation ((6.2±1.8)mmol/L vs.(3.7±1.2)mmol/L)(t=-6.89, P<0.01). The cure rate was 100% as all the patients' symptoms were disappeared during follow-up time.

CONCLUSIONSCombination IOUS is a highly sensitive method for the localization of insulinoma, which is helpful in localizing tumors precisely in insulinoma cases assisted by robotic surgical system and shortening operation time.It is safe and effective for insulinoma enucleation.

Blood Glucose ; analysis ; Humans ; Insulinoma ; diagnostic imaging ; surgery ; Operative Time ; Pancreas ; diagnostic imaging ; surgery ; Pancreatic Neoplasms ; diagnostic imaging ; surgery ; Postoperative Complications ; Retrospective Studies ; Robotic Surgical Procedures ; Ultrasonography

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The clinical and pathological research of complete mesocolic excision on the treatment of right colon cancer.

Yingchi YANG ; Jin WANG ; Lan JIN ; Xiaomu ZHAO ; Guocong WU ; Kangli WANG ; Zhongtao ZHANG

Chinese Journal of Surgery.2016;54(1):25-29. doi:10.3760/cma.j.issn.0529-5815.2016.01.007

OBJECTIVETo verify the clinical safety of complete mesocolic excision (CME) and manufacture pathological large slices.

METHODSA prospective analysis clinical data of 85 right colon cancer in patients by the same group of surgeons at the Department of General Surgery, Beijing Friendship Hospital, Capital Medical University from January 2012 to December 2013 which were divided into two groups: CME group (n=39) and traditional radical operation group (n=46) by surgical approach. CME group and control group were compared the differences of clinic and pathologic variables, precise tissues morphometry, lymph nodes harvest, mesocolic area and so on. By comparison to operation time, blood loss, postoperative complications, flatus restoring time, drainage removal time and length of stay, the security of CME was analyzed. Statistical methods included independent sample t-test, Wilcoxon rank sum test and χ(2) test. In order to manufacture pathological large slices, the CME operation specimens were fixed. The large slices were stained by routine HE staining to detection of circumferential resection margin.

RESULTSMean number of total lymph nodes was increased obviously in CME group (26.8±1.9 vs. 23.2±3.4, t=4.261, P=0.000). Mean number of lymph nodes of stage Ⅰ, Ⅱ were different between two groups (25.8±3.6 vs. 18.2±4.5, 26.8±7.7 vs. 24.9±6.2, t=8.776, 2.802, P=0.000). The positive lymph nodes of CME group was higher than control group (4(7) vs. 1.5(2), P=0.032), above all with statistically significant difference. Comparing CME group with the control group, there were the larger area of mesentery ((15 555±1 263) mm(2) vs. (12 493±1 002) mm(2,) t=12.456, P=0.000), the greater distance between the tumor and the high vascular tie ((116±22) mm vs. (82±11) mm, t=9.295, P=0.000), the greater distance between the normal bowel and the high vascular tie ((92±17) mm vs. (74±10) mm, t=8.132, P=0.000) of CME, with statistically significant difference. There were no statistically significant differences from operation safety when CME group was compared with the control group. The pathological large slices of colon cancer were prepared successfully and dyed evenly than those large slices were used to observe whether the lymph tube and lymph node metastasis inside the mesocolon. Existence of direct tumor invasion could be confirmed by investigating the large slices. Cancer embolus in intravascular and micro infiltration in mesocolon also could be found.

CONCLUSIONSCME operation can get the standard excision according the mesocolic area and integrity, as well as to harvest the maximum number of lymph node. The clinical application of CME is safe and does not increase the risk of operation. Circumferential resection margins can be detected by pathological large slices.

Colectomy ; Colonic Neoplasms ; surgery ; Device Removal ; Humans ; Lymph Node Excision ; Lymph Nodes ; Lymphatic Metastasis ; Mesocolon ; surgery ; Operative Time ; Postoperative Complications ; Prospective Studies

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Impact of octreotide on pancreatic fistula after pancreaticoduodenectomy: a prospective study.

Rui KONG ; Jisheng HU ; Le LI ; Gang WANG ; Hua CHEN ; Xuewei BAI ; Yongwei WANG ; Linfeng WU ; Hongchi JIANG ; Bei SUN

Chinese Journal of Surgery.2016;54(1):21-24. doi:10.3760/cma.j.issn.0529-5815.2016.01.006

OBJECTIVETo investigate the effect of utilizing octreotide during perioperative period on pancreatic fistula after pancreaticoduodenectomy (PD).

METHODSThree hundreds and six patients admitted from January 2010 to October 2014, who prepared to undergo pancreaticoduodenectomy (PD) were randomly divided into octreotide group (147 cases) and control group (159 cases). In octreotide group, octreotide was used in subcutaneous injection instantly after PD, each 8 hours until postoperative 10(th) day, and patients in control group were injected with the same volume of saline. Differences of pancreatic fistula (Grade A, Grade B, Grade C), hospitalization days and treatment cost were compared. χ(2) test, t-test and Fisher exact test were used to analyzed to the data, respectively.

RESULTSNo statistical significance (P>0.05) between two groups in the incidence of pancreatic fistula after PD (Grade A: 8.8% vs. 10.2%, Grade B: 2.7% vs. 4.4%, Grade C: 0.7% vs. 1.3%; χ(2)=0.197, 0.700, 0.288; P=0.657, 0.403, 0.591), the length of hospitalization((12.1±1.2)days vs. (13.0±1.2)days)(t=1.711, P=0.104) and treatment cost (79 700±6 700 vs. 77 600±5 200)(t=1.378, P=0.185). When accompanied with high risk factors, such as soft texture of pancreas, pancreatic duct size less than 3 mm, BMI≥25 kg/m(2) and diabetes, compared with control group, octreotide group had the lower incidence rate of pancreatic fistula and clinical correlative pancreatic fistula(all P<0.05) after PD.

CONCLUSIONSGenerally, octreotide makes no contribution to reduce the incidence of pancreatic fistula after PD. However, for patients who is accompanied with high risk factors, such as soft texture of pancreas, pancreatic duct size less than 3 mm, BMI≥25 kg/m(2) and diabetes, octreotide can effectively prevent pancreatic fistula after PD.

Anastomosis, Surgical ; Humans ; Incidence ; Octreotide ; therapeutic use ; Pancreas ; pathology ; Pancreatectomy ; Pancreatic Ducts ; pathology ; Pancreatic Fistula ; drug therapy ; Pancreaticoduodenectomy ; adverse effects ; Perioperative Period ; Prospective Studies

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Therapeutic effect and long-term follow-up of the Jinling procedure for refractory constipation: a series of 1 100 cases.

Jun JIANG ; Qiyi CHEN ; Xiaobo FENG ; Ling NI ; Jianlei LIU ; Yu HUANG ; Yifan SHI ; Jieshou LI ; Ning LI

Chinese Journal of Surgery.2016;54(1):13-20. doi:10.3760/cma.j.issn.0529-5815.2016.01.005

OBJECTIVETo investigate the safety, effectiveness and long-term results of Jinling procedure.

METHODSA total of 1 100 patients with refractory constipation were admitted to the Institute of General Surgery between February 2000 and December 2013 and received Jinling procedure. There were 217 male and 883 female patients with an average age of (45±15) years and an average duration of (275±159) months. The Jinling procedure modifies the classic procedure of subtotal colectomy with colorectal anastomosis by adding a new side-to-side cecorectal anastomosis. The general clinical data, postoperative complications, gastrointestinal quality of life index (GIQLI), Wexner constipation score, satisfaction rate, body composition, nutritional status, homeostasis, anal manometry and defecography during follow-up were collected. Statistical analysis was performed by t-test analysis, χ(2) test or Fisher's exact probability.

RESULTSThe postoperative follow-up rate were 96.73%, 94.36%, 93.00% and 92.55% at 1, 3, 6, and 12 months. The satisfaction rate were 62.50%, 72.45%, 93.16% and 94.70% respectively during 1, 3, 6 and 12 months follow-up. The postoperative 1 month, GIQLI was lower than that of preoperative (P=0.038), but significantly better at postoperative 3 month than the preoperative (P=0.022), and gradually improve after then. Wexner score was significantly lower at postoperative 1 month than the preoperative (P=0.018), and with the gradually reduce. Compared to the preoperative baseline, all body composition and serum protein parameters decreased significantly at the one-month follow-up and then increased gradually over the remaining follow-up period. Weight and prealbumin were significantly higher than the preoperative at postoperative 12 month. Jinling procedure had no effect on electrolytes. All patients were detected in defecography before surgery, but these abnormal indicators were improved after surgery. Anal function, coordinated movement anorectal function, anorectal reflex and rectal sensation were injured at early postoperative, but as time goes on, these indicators gradually returned to preoperative levels, some indicators better than the preoperative level. Postoperative surgical site infection, anastomotic bleeding , anastomotic leakage, urinary retention, sexual dysfunction, recurrent constipation, bowel obstruction, anastomotic stricture and mortality rates were 4.36%, 5.45%, 6.00%, 6.91%, 0.64%, 0.45%, 8.82%, 4.00% and 0.27% respectively.

CONCLUSIONSJinling procedure is a safe and effective surgical procedure for refractory constipation. It can improve defecation function and quality of life significantly, and has a high follow-up satisfaction rate.

Adult ; Anastomosis, Surgical ; Colectomy ; Constipation ; surgery ; Defecation ; Defecography ; Female ; Follow-Up Studies ; Humans ; Intestinal Obstruction ; Male ; Middle Aged ; Postoperative Period ; Quality of Life ; Rectum ; Treatment Outcome

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Progress in diagnosis and treatment of deep venous thrombosis after total joint arthroplasty.

Zhenpeng GUAN ; Heng ZHANG

Chinese Journal of Surgery.2016;54(1):9-12. doi:10.3760/cma.j.issn.0529-5815.2016.01.004

Deep venous thrombosis (DVT) is one of the most common complications after total joint replacement, which is also one of the most concerned problems for clinicians. Domestic research data shows that the incidence of DVT in patients without thrombotic prophylaxis after joint replacement surgery are 20.6%-40.0%. The occurrence mechanism of DVT is explained by the Virchow theory, that is blood stasis, the blood vessel wall damage and blood coagulation state. The diagnostic rate of DVT is not satisfactory. The diagnosis of symptomatic DVT depends mainly on clinical symptoms and auxiliary examination. The diagnosis of asymptomatic DVT is mainly based on the auxiliary examination. The prevention and treatment of DVT after artificial joint replacement is currently mainly concentrated in the aspects of new oral anticoagulant agents, drug prevention method, and time limit.
Anticoagulants ; therapeutic use ; Arthroplasty, Replacement ; adverse effects ; Blood Coagulation ; Humans ; Incidence ; Venous Thrombosis ; diagnosis ; therapy

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Current status and prospect of enhanced recovery after surgery.

Zhiwei JIANG ; Jieshou LI

Chinese Journal of Surgery.2016;54(1):6-8. doi:10.3760/cma.j.issn.0529-5815.2016.01.003

Since the concept of fast track surgery (also known as enhanced recovery after surgery (ERAS)) was first introduced by Professor Kehlet in 1997, it has been 18 years of clinical practice. Significant progressions have been made in different fields of surgery, generally, in reducing the surgical stress, reducing the postoperative complications, and shortening the length of hospital stay. It has also been over ten years since the first research of ERAS in China. However, there are still some difficulties and obstacles in clinical applications, especially from the traditional habit. Thus, future studies of surgical stress and the regularity of metabolism are needed. The existing evidence of researches on ERAS should be translated into clinical application. Therefore, the aim of free-pain and no risk surgery will be achieved.
China ; Humans ; Length of Stay ; Postoperative Complications ; prevention & control ; Postoperative Period

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The present situation and future development for laparoscopic surgery for gastric cancer in China.

Peiwu YU ; Yingxue HAO

Chinese Journal of Surgery.2016;54(1):2-5. doi:10.3760/cma.j.issn.0529-5815.2016.01.002

Laparoscopy assisted gastrectomy is one of the main directions of minimally invasive surgery for gastric cancer in China. Since 1999, the first laparoscopy assisted gastrectomy was reported, the hospitals which performed laparoscopy assisted gastrectomy and the reported cases have been increasing. The surgical technique are more and more experienced and acquire satisfied clinical results. However, there is still lack of standard and insufficient evidence in the treatment of gastric cancer by laparoscopy assisted gastrectomy. The robotic gastrectomy is still not operated in the most hospitals in China. So we should promote the standardization of laparoscopic gastric cancer surgery, strengthen the evidence based medicine research, and actively carry out the robotic operation of gastric cancer to enhance the level of minimally invasion surgery for gastric cancer in China.
China ; Evidence-Based Medicine ; Gastrectomy ; Humans ; Laparoscopy ; Minimally Invasive Surgical Procedures ; Robotic Surgical Procedures ; Stomach Neoplasms ; surgery

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Research progress in the relationship between pancreatic carcinoma and glycolysis.

Jiapeng HUANG ; Chunlin GE ; Email: GECHUNLIN@139.COM.

Chinese Journal of Surgery.2015;53(10):798-800.

Pancreatic carcinoma is currently one of the most intractable malignant tumors of the digestive tract. Studies have found that the occurrence, progression and metastasis of pancreatic carcinoma are closely associated with the tumor's glycolytic pathway, most pancreatic carcinomas show the elevated glycolytic phenotype. To some extent, affecting the glycolytic pathway can influence the energy metabolism of the tumor without affecting the normal cells theoretically. Therefore, glycolytic pathway may become a new target for the treatment of pancreatic carcinoma.
Energy Metabolism ; Glycolysis ; Humans ; Pancreatic Neoplasms ; metabolism ; physiopathology

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Anatomic segmentectomy for early stage non-small cell lung cancer.

Xiuyi ZHI ; Email: XIUYIZHI@ALIYUN.COM. ; Hui LI

Chinese Journal of Surgery.2015;53(10):794-797.

Anatomic segmentectomy is alternative to lobectomy for the surgical treatment of selected patients with early stage non-small cell lung cancer. Segmentectomy can reserve more pulmonary function in such patients. Emerging evidence suggests that segmentectomy may offer survival outcomes approaching that of lobectomy for lung cancer patients whose disease meets the following criteria: stage IA disease with no regional lymph node metastasis; tumor up to 2 cm in diameter; located in the periphery of lung; and predominantly ground-glass appearance on CT imaging. Compare with wedge resection, segmentectomy obtained the best results. Nevertheless, the evidence is currently still limited, and the above criteria are met only in a minority of patients. Large randomized trials are underway to define the clinical role of segmentectomy, and results are eagerly anticipated. Until that time, lobectomy should still be regarded as the standard therapy for patients with early stage non-small cell lung cancer.
Carcinoma, Non-Small-Cell Lung ; surgery ; Humans ; Lung Neoplasms ; surgery ; Neoplasm Staging ; Pneumonectomy ; methods ; Tomography, X-Ray Computed

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Early-stage lung cancer manifested as ground-glass opacity.

Gening JIANG ; Email: JGNWP@ALIYUN.COM. ; Dong XIE

Chinese Journal of Surgery.2015;53(10):790-793.

The incidence of ground-glass opacity (GGO)-dominant lung cancer is rising in China. The review is focused on the diagnosis and therapy for GGO-dominant lung cancer. CT screening in high-risk groups is recommended for early diagnosis of GGO-dominant lung cancer. The early diagnosis of GGO-dominant lung cancer depends on dynamic observation on the chest CT. Non-surgical biopsy or PET/CT has limited diagnostic value in GGO-dominant lung cancer. Video-assisted Thoracoscopic resection (VATS) is the mainstream treatment for GGO-dominant lung cancer. Single-port VATS, VATS segmentectomy, robot-assisted VATS, and subxiphoid VATS are the new directions of minimally invasive surgery. GGO intraoperative localization can be integrated using a variety of models. Sublobectomy could be used in the therapy for adenocarcinoma in situ, minimally invasive adenocarcinoma or pure GGO with 2.0 cm or less in diameter. Surgery for multiple GGO need an individualized strategy.
Adenocarcinoma ; surgery ; China ; Humans ; Lung ; pathology ; Lung Neoplasms ; diagnosis ; surgery ; Positron-Emission Tomography ; Thoracic Surgery, Video-Assisted ; Tomography, X-Ray Computed

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